There's still much to learn about long-term health effects of last year's fires

Frank Walden of Big Bar gets an echocardiogram done at The Cardiovascular Center in Redding on Wednesday. Walden says he still suffers from upper respiratory problems and was admitted to the hospital a few weeks earlier with a heart rate of 141 beats per minute, double his normal rate. Andreas Fuhrmann/Record Searchlight

This project is the result of a partnership between the Redding Record Searchlight and the Center for California Health Care Journalism. The center is an independent organization devoted to reporting about health care issues that concern Californians. It is supported by USC's Annenberg School of Journalism and funded by the nonprofit, nonpartisan California Health Care Foundation.

The smoke crept in during the final weeks of June. From the blazing forest, it reached its ashy brown fingers into Frank Walden's garden, choking his corn and poisoning his apple trees. It snuck under the doorway of his three-bedroom home on the edge of Big Bar. It entered his lungs. It refused to leave.

Ten months after the lightning storms that triggered 136 wildfires in the Shasta-Trinity National Forest and clogged this region with smoke for an entire summer, Frank Walden doesn't feel much better. His resting heart rate recently clocked in at 141 beats per minute - twice as fast as normal, he says. He struggles to catch his breath.

"It probably took years off me," says Walden, 75, his voice now scratchy like a smoker's, though he's never lit up. "By damn, those fires have done me bad."

Last summer's fires left a physical imprint on all the state's northernmost landscapes, but perhaps none so much as Trinity County's. The lush green hills here are now heavily patched with brown tree skeletons. Some residents say the fires also cast another, less tangible shadow: on their lungs.

The short-term public health effects of wildfires are well documented. As smoke triggers asthma and exacerbates existing heart and lung issues, emergency room visits and hospitalizations tend to go up. With the likelihood of future fire outbreaks increasing due to drought and global warming, locals wonder whether wildfire smoke may become a constant part of their lives - and whether it will have a significant longer-term health impact. The issue has attracted scant research; some experts believe a sure answer may never be known.

Chronic problems

Still, patients scattered across this region feel certain the effects are real. Some, like Frank Walden, say they were healthy before the fires, then fell seriously ill as a result of the smoke. Others say they were chronically ill before the lightning storm hit - and have grown even sicker since.

These patients' experiences have led some local officials to raise an alarm about the fires, calling on everyone from the U.S. Forest Service to the Federal Emergency Management Agency (FEMA) to consider the health-related dangers of smoke when setting policies about forest management and disaster response. Too frequently, they say, those dangers - and the people who suffer the results - are forgotten in the larger policy debate.

"They're sick for 10, 15, 20 years from the effects of smoke, and nobody's held accountable for that," said Rod Mendes, director of the office of emergency services for the Hoopa Tribe near Humboldt.

"And they should be held accountable."

The fires, experts say, were not an aberration. With global warming kicking into higher gear, wildfires are widely predicted to become more frequent, and more intense. A recent report from the state's Climate Action Team predicts that, by the end of this century, the amount of forest land burned in the northern part of the state will easily double. Any impacts that fires currently have on health will likely be magnified in the future, local officials say.

"These fires are just like having nuclear waste facilities in the inner city," said Jeff Morris, a former Trinity County supervisor. "But if this were the inner city, people would be screaming their heads off."

'Love Canal effect'

While the entire region choked on smoke last summer, densely forested Trinity County was particularly hard hit. Last fire season, the county had 87 days of unhealthy air.

Jim French, Trinity County's superintendent of schools, said he's concerned the smoke might be damaging children's lungs. Many parents, including Cindy Winter, 46, of Hyampom, are worried as well. She kept her 10- and 14-year-old sons indoors all summer. "It was a concern for all the parents I knew locally," she said.

French speaks in even starker terms.

"It could be having a cumulative Love Canal impact on us," he said, referring to the Niagara Falls, N.Y., community that built a school and a small town on a known toxic waste dump, leading to birth defects, skyrocketing leukemia rates and other health problems.

Indeed, children, even those who seem healthy, are vulnerable to maladies caused by smoke.

A 2006 University of Southern California study found that children in the San Diego area flooded doctors' offices complaining of nose, eye and throat irritations from smoky air caused by the October 2003 wildfires that burned more than 1,000 square miles.

What shocked researchers was that children who had never experienced asthma suffered as much as those who'd had it before.

The study, based on surveys of area residents, didn't address long-term impacts.

The San Diego fires lasted about a week. In two of the last three years, fires on national forest land in Trinity County have burned for months.

Most remember the lightning storm that hovered over the county on June 20, triggering fires that eventually would burn 190,000 acres in the Shasta-Trinity National Forest alone. Darryl Siliha, 59, a Weaverville resident who suffers from chronic obstructive pulmonary disease and congestive heart failure, says he heard the first cracks of dry lightning and thought: "Uh-oh. Something's going to come of this."

But even with the dramatic introduction from Mother Nature, few were prepared for the thick brownish smoke that enveloped many of the region's towns and hamlets. Because the sun couldn't shine through it, the air near the ground didn't warm. The resulting inversion - a layer of hot air floating above a layer of cold air - worked as a sort of atmospheric lid, keeping the smoke from floating away. Drivers turned their headlights on at all hours. Neighbors couldn't see each others' houses.

'Like breathing through a straw'

Last summer's smoke was so thick for so long, in fact, that most local doctors say they're surprised they didn't see more patients pouring into their clinics with breathing problems. Doctors attribute the lighter-than-expected patient load, at least in part, to a public information campaign by local media telling people to stay inside, keep doors and windows closed and buy masks and air filters. They also say instinct may have played a role - most people avoided going outside, where the air was smoggy and every breath stabbed the lungs. Nevertheless, with so many older homes in the area, and many of them without air conditioning, experts say the indoor concentration of fine particles can reach 70 percent or more of outside levels.

Dr. Don Krouse, a family practice physician with offices in Weaverville and Hayfork, said his staff had prepared for an onslaught of patients with acute respiratory problems. It never materialized. What Dr. Krouse did notice was a handful of people with no history of respiratory troubles falling seriously ill, to the point of hospitalization. Some continue to feel sick to this day.

"Just anecdotally, I have a number of patients say they've felt terrible since the summer," Krouse said. "Maybe it was just how dramatic the event was, but they say, 'I haven't felt well since then.' "

One of Dr. Krouse's patients, Sherry Forslund, 63, said she'd initially thought she had a chest cold. Then her lungs seemed to close up. "I felt like I was breathing through a straw," she said. Eventually she spent four days in the hospital, pumped full of steroids, antibiotics, oxygen and morphine. She's healthier now, she says, but only after months of discomfort.

'The billion-dollar question'

Medical expert opinions are still mixed on the question of what cases like Forslund's might tell us about the health impacts of smoke. Longer-term studies tend to focus on firefighters, not the general public. After being routinely exposed to large amounts of smoke, firefighters suffer high rates of chronic bronchitis and other respiratory problems. But, in the absence of other evidence, experts still have doubts about whether one bad summer - or even a string of them - can make otherwise healthy people chronically ill.

Dr. Sverre Vedal, a University of Washington professor who has studied the impact of wildfire smoke on mortality, calls that "the billion-dollar question."

"My sense is, developing chronic disease based on that sort of exposure is unlikely," he said. As fires - and exposures - become more frequent, he said he'd expect to see more short-term, acute effects.

There is certainly a good deal of evidence that wildfire smoke makes people sick in the short term. In July and August 2008, Shasta Regional Medical Center in Redding saw 806 people come into the ER complaining of shortness of breath. During the same two months the previous summer, they'd seen 511. (Across town, Mercy Medical Center's ER admissions for breathing issues actually dropped significantly in July 2008, then spiked up in August and September.)

Michael Lipsett, chief of environmental health investigations for the California Department of Public Health says wildfires are "a very important concern for public health officials." Exposure to the particles found in other types of pollution, he says, has enormous impact on people's health - "and there's no reason to expect that the effects of wildfire smoke are going to be any different."

Lipsett, like most experts on wildfire smoke inhalation, says there is still a good amount that is not known, both about wildfire smoke's long-term health effects, and about how it might link to cardiovascular disease. Studying long-term effects would be very difficult, he says, and he imagines few agencies would be interested in funding it.

Anecdotal evidence

But such research is nevertheless important, said Dr. Eva Smith, medical director of the K'ima:w Medical Center in the Hoopa Valley near Humboldt. Last summer, she noted a dramatic increase in the number of people asking for inhalers, as well as suffering from eye irritation and headaches.

A decade ago, during the Megram Fire, which burned from August until November 1999, Dr. Smith documented similar problems. She remembers calling every agency she could think of, hoping to gather information about the effect the smoky air might be having on public health. No one could tell her anything.

"It was just beyond my belief that nobody knew what happens to people in a forest fire," she said. The Center for Disease Control and Prevention eventually came in to help Smith study the problem in the short term. But more research needs to be done about long-term effects, she says. Anecdotally, she said, "people will say 'my lungs have been messed up from 1999, I was healthy before 1999.' "

Research or not, many residents of Trinity County say they see evidence of a problem in their friends and neighbors.

Many who live in this region say they consider fires - and smoke - to be an inevitable aspect of mountain life.

Still, some local officials say they need more help from the state and federal government to protect people's health. In part, that might involve helping people avoid smoke - providing them with air filters and clean air centers, evacuating them if need be.

California Sen. Sam Aanestad, R-Grass Valley, is pressing FEMA to provide quicker relief when the smoke gets thick, said his field representative, Nadine Bailey. She says it's potentially dangerous for residents to have to wait for a state proclamation, then a presidential order before they can access federal help.

A secondary consideration

If federal officials managed the fires better to start with, they wouldn't grow so large - or so smoky, said David Rhodes, chairman of the Concerned Citizens for Responsible Fire Management, an advocacy group based in Trinity County. His group, reflecting a view shared by many Trinity County residents, has criticized the additional smoke generated by the U.S. Forest Service's policy of setting burnout fires to fight fires.

"We've had people coughing since last summer and the coughing hasn't gone away," he said.

A spokesman for the Shasta-Trinity National Forest Service, Kent Romney, said fire commanders prioritize public and firefighters' safety in their day-to-day decisions, followed by protecting forests, watersheds, homes, businesses, roads and power lines. Air quality is "secondary to the immediate life-safety issues," he said, but is a factor in how a commander will act on a given day, including whether to light burnouts.

"We do our best," said Sharon Heywood, supervisor for the Shasta Trinity National Forest. "... And, at the time, I would say life and property take the higher priority. But, that said, air quality is addressed, and I can't be a lot more specific than that. But we do recognize that communities are impacted by the smoke."

Solutions needed

Morgan Varner, an assistant professor of wildland fire management at Humboldt State, says the smoke would be there, regardless of what firefighting strategy was employed. To address the low air quality, he agrees with locals who think federal officials need to institute more aggressive policies to prevent the forest from getting so overgrown. That might include intentionally allowing low-intensity fires to burn through underbrush, or using machinery to grind it into mulch. Using prevention, Varner said, the federal government might better avoid last summer's scenario, when the whole state seemed to be burning at once.

"That's a disaster situation and that's not what fire should be," he said.

In one little corner of the forest, last summer's fires felt like not only a policy disaster, but also a personal one. The smoke hurt Frank Walden's lungs; the fires nearly broke his heart.

Fifty years ago, Walden and his wife moved from Los Angeles to their 15-acre patch of Trinity County, having fallen in love with the pure air, the sparkling creeks, the gray squirrels, quail and blue jays that cavorted among the trees. They built a modest house from scratch and raised four daughters in it. Walden familiarized himself with every maple, every live oak, every Douglas fir. Now, as he stands on a hillside, tallying his blackened losses, he pauses frequently to catch his breath. He can't walk more than a few yards at a time.

"It's been awesome living here, until the fires," he says.

Then, a few moments later: "I don't know what we'll do should it happen again."